Holter Monitor versus Cardiac Event Monitor
Holter Monitoring and Cardiac Event Monitoring are two useful tools for clinicians to monitor a patient’s ECG. Both a Holter Monitor as well as a Cardiac Event Monitor are used to connect patient symptoms to cardiac electrical abnormalities. Each ambulatory cardiac monitoring tool has its strengths and limitations therefore are often used for slightly different purposes. Lets take a look at the definition of each cardiac monitoring study to begin our discussion of when each should be used.
Holter Monitoring – 24 hour continuous recording of (all) ECG information. The average 24 Hour Holter has 110,000 beats.
Cardiac Event Monitoring – Up to 30 days of (patient activated or automatically activated) ECG information surrounding the symptom or abnormality only.
Traditionally, the Holter Monitor study is ordered prior to a long term Cardiac Event Monitor study. However in recent years, both Medicare and most insurance companies will cover an Cardiac Event monitor in place of or prior to a Holter Monitor study if the clinician deems the symptoms or arrhythmias too transient to be captured in a 24 hour period. Common cases include transient arrhythmias such as Atrial Fibrillation, Bradycardia, Tachycardia & Syncope. In these instances, the ordering physician may recommend a Cardiac Event Monitor study prior to a Holter Monitoring study.
Cardiac Event Monitoring can be prescribed for a specified amount of time, or monitored daily with newer technology such as Mobile Cardiac Telemetry. The durations can vary as patient wear the Cardiac Event monitor until either the symptom is captured (symptomatic event monitor), or until the cardiac abnormalities are captured by the event monitoring device. At which time, the stored cardiac event is transmitted by the patient or automatically by the device to a diagnostic laboratory for review. Cardiac Event Monitors can be worn for a period of up to 30 days if the laboratory has not received any relevant or abnormal transmissions from the Cardiac Event Monitor.
The indications of use for Holter Monitoring and Cardiac Event Monitoring is generally straight forward but they can vary (slightly) from one insurance carrier to the next. We advise referencing the Local Coverage Determination for Medicare as well as the appropriate insurance carrier for exact details. You may also reference the National Coverage Determination from Medicare for ambulatory cardiac monitoring on right side of the page.